MEDICARE: DR. DOUGLAS BRANT JR. D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	3443	OK

General Provider Information

NPI Number	:	1588656094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS BRANT JR. D.O.

Provider Business Mailing Address
First Line	:	612 WEST BYPASS
Second Line	:
City	:	DRUMRIGHT
State	:	OK
Zip	:	74030-5954
Country	:	US
Telephone Number	:	918-382-5955
Fax Number	:

Provider Business Practice Location Address
First Line	:	612 WEST BYPASS
Second Line	:
City	:	DRUMRIGHT
State	:	OK
Zip	:	74030-5954
Country	:	US
Telephone Number	:	918-382-5955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	05/18/2012

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